[Assessment of healthcare status and therapeutic recommendations concerning attention deficit hyperactivity disorder]

Lasa-Zulueta A, Jorquera-Cuevas C
Record ID 32011000117
Original Title: Evaluación de la situación asistencial y recomendaciones terapéuticas en el trastorno por déficit de atención e hiperactividad
Authors' objectives: The aims of this study are as follows: a) to determine the demand for care relating to this problem in the public mental health services of the Autonomous Community of the Basque Country (ACBC); b) to determine the opinion of the health professionals who deal with these cases and procedures they follow both in Mental Health and in Primary Care Paediatrics; c) to determine the level of consumption of methylphenidate in our community; d) to make a critical assessment of current clinical practice guidelines for treating Attention Deficit Hyperactivity Disorder (ADHD); e) to issue a number of recommendations for clinical practice based on the conclusions obtained.
Authors' results and conclusions: — In Mental Health services the diagnosis of ADHD is confirmed only in 24% of direct consultations or referrals in those cases when this disorder is suspected. Even so, the incidence of the diagnosis in those services tripled from 2001 to 2007. — Both in the literature and in clinical practice, the differences in care and therapeutic criteria between the two main healthcare services for children (Mental Health and Primary Care Paediatrics) is confirmed. — The prescription of methylphenidate has increased enormously over recent years in the ACBC, increasing 18-fold from 2001 to 2007. The increase was much greater in primary care than in mental health. — Only 3 of the 9 CPGs on ADHD evaluated were «very recommendable» according to the assessment made with the AGREE instrument. — Both in the scientific evidence and in the CPGs based on it, there is a certain amount of bias and a number of conflicts of interest that blemish the credibility and objectivity of the declarations and recommendations they make, thus reducing their quality.
Authors' recommendations: - The diagnostic suspicion and concern surrounding ADHD is much greater than its real incidence. - There is still no concensus or clarity concerning many of the aspects of this disorder and the way in which this is treated. - It is necessary to determine who are the right professionals in our health system to take overall responsibility for the care and management of this problem and to establish inter- professional protocols and coordination in order to ensure that our services operate more efficiently. - A critical and cautious reading must be made of the evidence published on ADHD. - It is advisable to follow cautious recommendations regarding the prescription of methylphenidate in order to avoid unnecessary medicalisation and risks in the case of infants.
Authors' methods: - Systematic review of information sources and databases available on international Clinical Practice Guidelines in order to make a critical assessment of these using the AGREE instrument, as well as a bibliographical review of the management of ADHD within the context of our own health care system. - Descriptive retrospective study: gather of data in the Mental Health services for infants and young children in the Basque Health Service (Osakidetza), through a review of clinical records and a questionnaire for professionals, as well as an additional questionnaire for Primary Care paediatricians. - Consultation and analysis of the PCR data (psychiatric cases registry) obtained from these services with regard to the incidence and prevalence of ADHD. - Consultation and analysis of data on the prescription of psychostimulants over the last years in the ACBC.
Project Status: Completed
Year Published: 2010
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Attention Deficit Disorder with Hyperactivity
  • Attention Deficit Disorder with Hyperactivity
  • Practice Guidelines
  • Mental Health
  • Primary Health Care
  • Pediatrics
  • Therapeutics
  • Health Services Needs and Demand
  • Methylphenidate
  • Metilfenidato
  • Necesidades y Demandas de Servicios de Salud
  • Tratamiento
  • Pediatría
  • Atención Primaria
  • Salud Mental
  • Guías de Práctica Clínica
  • Trastorno por Déficit de Atención con Hiperactividad
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.